Management of intraoperative right ventricular failure with pulmonary artery balloon counterpulsation

There are many etiologic factors that contribute to the development of right ventricular failure. However, the clinical manifestations and treatment modalities parallel whether the causative factor is from intraoperative complications or cardiovascular pathology. When adequate preload and pharmacologic support fail to enhance right ventricular function, the placement of a pulmonary artery balloon catheter for counterpulsation may be required. Currently, the pulmonary artery balloon catheter requires intraoperative placement. However, further research and refinements may allow peripheral placement of the catheter, using a smaller sized balloon. A case study is presented of a patient requiring intraaortic and pulmonary artery balloon counterpulsation for intraoperative right ventricular failure, after a mitral valve replacement.